The effect of caffeine loading on cerebral autoregulation in preterm infants.

Abstract

To evaluate cerebral autoregulation changes in preterm infants receiving a loading dose of caffeine base. In a cohort of 30 preterm infants, we extracted measures of cerebral autoregulation using time and frequency domain techniques to determine the correlation between mean arterial pressure (MAP) and tissue oxygenation index (TOI) signals. These measures included the cerebral oximetry index (COx), cross-correlation and coherence measures, and were extracted prior to caffeine loading and in the 2hours following administration of 10mg/kg caffeine base. We observed acute reductions in time domain correlation measures, including the cerebral oximetry index (linear mixed model coefficient -0.093, standard error 0.04; p=0.028) and the detrended cross-correlation coefficient (ρ5 coefficient -0.13, standard error 0.055; p=0.025). These reductions suggested an acute improvement in cerebral autoregulation. Features from detrended cross-correlation analysis also showed greater discriminative value than other methods in identifying changes prior to and following caffeine administration. We observed a reduced correlation between MAP and TOI from near-infrared spectroscopy following caffeine administration. These findings suggest an acute enhanced capacity for cerebral autoregulation following a loading dose of caffeine in preterm infants, contributing to our understanding of the physiological impact of caffeine therapy.